Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: The Village Nursing Home 41 Church Road Banks Southport Lancashire PR9 8ET The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jennifer Hughes
Date: 0 9 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home
Name of care home: Address: The Village Nursing Home 41 Church Road Banks Southport Lancashire PR9 8ET 01704220061 Telephone number: Fax number: Email address: Provider web address: village.manager@craegmoor.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Jacqueline Murphy Type of registration: Number of places registered: Parkcare Homes Ltd care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: 2 named service users in the category of PD (physical disability) Up to 2 service users in the category of PD (Physical Disability). Up to 20 service users in the category OP (Old Age) who need personal care only. Up to 38 service users in the category OP (Old Age) who need nursing care. Date of last inspection Brief description of the care home The Village is a forty-bedded, purpose built, care home, set in its own well-maintained grounds. It is located in the village of Banks and there are sufficient amenities of shops, a Church and public house nearby. Transport links to nearby towns of Southport and Liverpool can be accessed. There is ample car parking space alongside the home. The home provides personal and nursing care for older people, and is well equipped to Care Homes for Older People
Page 4 of 32 Over 65 38 0 0 4 Brief description of the care home suit the needs of its residents. All accommodation is at ground floor level, and there is easy access for wheelchair users and the less mobile. All rooms have an en-suite facility and there are two shared rooms. Communal space for service users comprises a lounge, dining area and two small seating areas along the corridors. The home has a patio area to the front and garden and patio to the rear. Qualified nursing staff and care staff are provided over 24 hours, every day of the year. Residents receive information about the home in the form of the Statement of Purpose and the Service Users Guide. A small brochure is also given out to anyone making enquiries. As at October 2008 the fees charged ranged from £366.00 per week, to £550.00 per week, depending on the level of care needed. Care Homes for Older People Page 5 of 32 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection of this home included a site visit, which was carried out over one day. The site visit was part of the key inspection of the home. A key inspection takes place over a period of time, and involves gathering and analysing written information, as well as visiting the home. During the visit, we spent time speaking to residents, staff and the manager. We also spoke to some visitors. Every year the registered owners are asked to provide us with written information about the quality of the service they provide, and to make an assessment of the quality Care Homes for Older People
Page 6 of 32 of their service. It also asks about the managers own ideas for improving the service provided. We use this information, in part, to focus our assessment activity. Surveys were sent and received from residents and staff from the home, and the content from these is reflected in this report. During the site visit, staff records and resident care records were viewed, alongside the policies and procedures of the home. We also carried out a tour of the home, looking at both private and communal areas. Everyone was friendly and cooperative during the visit. What the care home does well: The management carry out clear pre-admission assessments to make sure the home can meet the needs of the person, before they say it is the right place for them. These are done by a visit to where the person is living, to discuss their needs with them and their family. People are able to view the home at any time. Residents told us that they had seen a few people having a good look around. All of the files have been updated with a new care planning system, and we saw that the care plan information is particular to each individual, giving a complete picture of them and how to look after them. Care plans also record the likes and dislikes of residents, and the important things in their lives, such as dogs, religion, or television, all with an explanation of why they are important. This enables staff to provide very person centred care, which centres on the perspective of the resident, rather than the staff. A staff member said The care needs are much clearer on the new system, and now we are getting used to it we are finding it a lot better. It has a lot more information about people, which is good. We spoke to staff, and they were clear on what support each person needed. A visiting relative we spoke to said that they were always kept informed on everything about their relatives care in the home. There are regular visits from health care professionals such as GPs, chiropodists, dieticians and physiotherapists, and records clearly note the reason for the visit, and the action taken by staff in response to it. One resident said Ive had the GP twice since Ive been here (2 months). And theyll arrange for staff to accompany you if you need to go to hospital. They bend over backwards to help you. The recruitment of an Activities Coordinator has improved the quantity and quality of activities in the home for all of the residents. He told us that he plans to develop the activities programme linked to individual abilities, so that no-one is left out. One resident said that since the activities coordinator had been employed a lot more things were going on. Since he arrived in the home to do activities he takes me to the local over 60s club twice a week. This was a problem before he came. I think it is good to get out as much as possible. Meals are served in a bright dining room at well set tables. The four week menu is varied, and fresh produce is used. We enjoyed a sample meal of a mixed grill followed by ginger sponge and custard, which was well cooked and presented. Most of the residents were seen to enjoy their meal, and we saw experienced care staff tactfully helping those who needed assistance with their meal. Relatives were welcome to stay and help their relative if they wished. Other dishes were offered. One resident did not want any of the sweet choices on offer, and the staff then suggested fresh fruit, which the resident enjoyed. Care Homes for Older People Page 8 of 32 There is a clear complaints procedure in place which is provided to all residents on their admission to the home. Records are kept of any concern raised, with detail of the homes investigation and response. Responses from surveys show that residents know how to make a complaint, and those spoken to said Id tell any of the staff, and I suppose Id tell the staff, but then Id go to the big boss if nothing happened. Staff are recruited following a strict procedure, making sure all checks are carried out before they start work. This ensures they are suitable to work with vulnerable adults. Its a nice place to work, and there seems to be more effort being made to support the staff, both through training courses, and one to one supervision sessions. The manager encourages openness and discussion on issues, stated a staff member. The manager told us Training of staff in appropriate key areas is a priority. Regular assessments of changing needs enable care to be provided that meets those needs. The running of the home is monitored by the organisation through monthly overview audits. These are done on specific areas, such as numbers of accidents, medication, finances, and infection control, and provides prompts for management in where they may be problem areas. Development plans are devised from all of these audits, with the aim being to continually improve the standard of the service. Feedback from residents and their families is encouraged through meetings and surveys, and the promotion of equal opportunities and open management. What has improved since the last inspection? What they could do better: The Statement of Purpose and Service User Guide needs to be kept up to date with information about the home, its staff, and the service it provides. The manager told us that she and the cook are in discussion about how the menus can Care Homes for Older People Page 9 of 32 be further developed, and have already improved the choices available at the tea time meal. This needs to continue and include residents opinions and suggestions. Residents who need soft and blended diets also need to find them appetising, so the presentation of these meals needs addressing to make them more attractive and encourage the resident to eat and enjoy their meal. Plans should continue to update and refurbish the environment, including ensuring the garden area is maintained. The bathroom areas are clean and tidy, but need to be presented in a more homely way to make bathing an enjoyable experience for residents. The staff team employed by the home needs to continue to be developed, so as to reduce the numbers of agency staff being used. This would provide more consistency, and a staff team who can work together with the same knowledge base of the residents and the care they need. The numbers of care staff who have achieved a National Vocational Qualification (NVQ) needs to continue to increase to reach at least 50 of the care staff numbers. Presently 42 hold the award. The results of any resident and relative surveys should be available to them, staff, and any interested parties. This is so that staff can see what areas they are performing well in and where they could improve, and so that residents and relatives can see that their opinions are taken into consideration in developing the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 32 Details of our findings
Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 32 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear assessment procedure, which is carried out for all people who live there. This means that the service provided is tailored to an individuals needs and preferences. Evidence: The majority of residents we spoke to, or contacted through surveys, said that they knew about the home before they moved in, and it was their relatives who made the decision it was the right place for them to be looked after. A Statement of Purpose and Service User Guide for the home are available in the hallway for all to see, and provided to all residents and interested parties. These give information about the service the home provides. Some of the information was out of date, and the manager confirmed that this was due to be updated. Care Homes for Older People Page 12 of 32 Evidence: The manager told us that people are able to view the home at any time, and residents said that they had seen a few people having a good look. The manager informed us that there had been a recent review of the assessment tool, or procedure used to assess need, and the information gathered during the assessment of need was now directly linked to the information held in the care plans for each resident. All prospective residents are assessed using the same procedures, showing equality of care. The assessment includes all aspects of physical, social and psychological care, and identifies the strengths and needs of the person. People are only admitted to the home if this pre-admission assessment shows that the home can meet the needs of the person. Three resident files were randomly selected, and we saw evidence of pre-admission assessments on them. The manager, or senior nursing staff carry out the assessment, usually by visiting prospective residents in their own homes. We saw that the assessments also include liaison with families, and other professionals. Signatures and dates confirm agreement with the resident. A formal contract is drawn up and provided to the resident. This explains the services provided, and what the fees are. All of the residents responding to the survey said that they held a contract. Intermediate care is not provided at this home. Care Homes for Older People Page 13 of 32 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of residents are met in this home. Residents benefit from the support of health care professionals. Evidence: Individual care plans are available, devised from the assessment information, identifying the areas of need for each person, and with clear instructions for staff on what they must do to meet that need. We saw these on the files we viewed. Since the last inspection all of the files have been updated with the new system, and the care plan information is particular to each individual, giving a complete picture of them and how to look after them. We advised that the manager needs to ensure all the areas are signed and dated by the staff who complete the document. She said that these are noted when she audits the files. Most of the people at the home were unable to say that they knew about their care plans, although one said They have something written about us so they know what to
Care Homes for Older People Page 14 of 32 Evidence: do. A visiting relative we spoke to said that they were always kept informed on everything about their relatives care in the home. All areas of the care plans were regularly reviewed, with an explanation of the decision made as a result. Daily notes were completed for each resident by staff, one entry for day, and one for overnight. These were clear and gave a good picture of events and the daily routines of the residents. We saw that healthcare opportunities were offered equally to all residents, and records of visits from health care professionals such as GPs, chiropodists, dieticians and physiotherapists clearly note the reason for the visit, and the action taken by staff in response to it. One resident said Ive had the GP twice since Ive been here (2 months). And theyll arrange for staff to accompany you if you need to go to hospital. They bend over backwards to help you. The care of a person with a pressure sore was well documented.The treatment required was clearly written, and an evaluation at each dressing change was recorded, resulting in the area completely recovering. Staff we spoke to said It is a nice place to work. We have had a lot of changes with different managers and staff and the new system of care planning to bring in. But the care needs are much clearer on the new system, and now we are getting used to it we are finding it a lot better. It has a lot more information about people, which is good. Discussion with, and observation of, staff, confirmed they were aware of the individual needs, and specialist needs, of the people living at the home. Staff spoke confidently about what help they gave to residents, which we confirmed linked to the care plans. Residents were either sitting in the lounges, or stayed in their own rooms if they wished, or if they were too poorly to move elsewhere. Staff were seen to treat residents with respect, knocking on doors before entering, sitting and quietly chatting with residents, and making sure bedroom doors were closed when carrying out care tasks. At this visit, we found that the Care Homes Effective Support Service (CHESS) was also visiting the home. This is a Primary Care Trust initiative, and consists of a team of community nurses and practice support pharmacists. The team visits care homes and aim to give older people better access and choice in healthcare. At this home they were reviewing all of the medication being taken by residents in the home to make
Care Homes for Older People Page 15 of 32 Evidence: sure peoples needs are being addressed proactively. This also includes examining records and storage of medication. We discussed their work, and they confirmed they also plan to advise the home on the training needs of nursing and care staff around medication. Due to this work, we did not feel it necessary to also examine the medication procedures, and the CHESS team said that they would inform CSCI if they had any concerns over practices in the home. Care Homes for Older People Page 16 of 32 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are appropriate activities so that people are provided with stimulation and able to lead fulfilling lives. The meals service needs to continue to improve so that all residents generally enjoy their meals all the time. Evidence: One resident said that since the activities coordinator had been employed a lot more things were going on. Since he arrived in the home to do activities he takes me to the local over 60s club twice a week. This was a problem before he came. I think it is good to get out as much as possible. The activities coordinator told us of his plans to develop the activities programme, and make sure all residents were included by providing stimulation linked to individual abilities. This may be through group activity and chat, or more personal and quiet one to one involvement. I choose not to attend activities. I enjoy the one to ones said a resident. A programme of planned events was on the noticeboard in the corridor. We saw the activities coordinator having a game of dominoes with a small group of residents in the
Care Homes for Older People Page 17 of 32 Evidence: lounge, where there was plenty of chat and banter. One resident told us of her surprise when the home had a visit from local schoolchildren, and they were from her old school. She enjoyed, as did other involved residents, telling the children about how the school was when she went there. At the last visit residents had problems with their television reception due to a poor signal in the area. All televisions now have digital aerials and good reception. Care plans also record the likes and dislikes of residents, and the important things in their lives, such as dogs, religion, or television, all with an explanation of why they are important. This enables staff to provide very person centred care, which centres on the perspective of the resident, rather than the staff. A visiting policy confirms that residents can see visitors in private if they wish. Several visitors called through the day of our visit, and they said that they were always made to feel welcome. Meals were served in the large, light dining room. Residents who ate there were sat at well set tables in small groups, which encourages conversation. The residents spoken to said that they sometimes enjoyed their meals. We saw that there is a four week varied menu, with the days choice on show in the entrance hall. The manager told us that residents are asked each day for their selection for the following days meals. She told us that, in discussion with the cook, they are gradually developing and improving the meals service. For example, rather than just soup and sandwiches on offer at tea time, there would be another choice such as a pasta dish. We enjoyed a well cooked sample main meal of a mixed grill, of egg, bacon, sausage, black pudding, beans and chips. This was followed by ginger sponge and custard. We saw that most residents enjoyed their meal, although those who were on a soft or blended diet need to be presented with a more attractive dish than was given them. Food presented in an attractive way will stimulate people to eat more. The manager agreed that this needs to be addressed. Residents in the dining room were treated well by experienced staff, who clearly knew the residents likes and dislikes very well. Residents felt confident to say I dont want that, and staff tactfully dealt with the situation. Other dishes were offered. One resident did not want any of the sweet choices on offer, and the staff then suggested fresh fruit, which the resident enjoyed.
Care Homes for Older People Page 18 of 32 Evidence: Some residents ate in their own rooms, and staff clearly had set routines on delivering meals and who would need assistance. Care Homes for Older People Page 19 of 32 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident their concerns will be listened to and acted upon. Staff have an understanding of safeguarding issues, which protect residents from abuse. Evidence: There is a complaints procedure in place, which is on view in the hall, and provided to all residents with the information given about the home when they are first admitted. The manager said that she plans to produce a more easy read version of the complaints procedure, which may mean larger print, or added pictures, so that it is easier to understand and so more accessible to all abilities. We saw a very structured system in place and full records of any concern raised by residents or their families, or other interested parties, with records of the investigation and response to the concern made by the home. The manager told us The home strives to have continual improvement on their agenda by listening and responding to the needs, wishes, and concerns of the individual. Responses from surveys show that residents know how to make a complaint, and those spoken to said Id tell any of the staff, and I suppose Id tell the staff, but then Id go to the big boss if nothing happened. Relatives we spoke to said they would go to the manager if they were not happy about something. Care Homes for Older People Page 20 of 32 Evidence: Staff records showed us that they had all had training in Safeguarding Adults, which is about being aware of how best to protect the people in their care. Staff we spoke to were able to discuss what they would do if they suspected any form of abuse was happening. The training is updated every year. The residents we spoke to said that they felt safe and well looked after. Care Homes for Older People Page 21 of 32 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents live in a generally pleasant, safe and clean environment. Evidence: In general the exterior and interior of the home present as well kept, clean and safe. There is plenty of garden area around the home, which is all accessible to residents. This area could be developed with more protected seating areas to make it a pleasant place for residents to sit in the warmer weather. At our visit the garden was starting to look untended, and the manager reassured us that plans were in place to keep the grounds maintained. Residents who are able presently sit on seating outside the entrance to the home when they want a change, enjoying watching the comings and goings there. All of the bedrooms are ensuite, and the two shared bedrooms have partition curtains for when residents want privacy. New beds and mattresses have been provided for residents since out last visit. Bedroom doors have locks, and residents are provided with keys. The rooms we looked at were full of personal possessions, from photographs, pictures and ornaments, to small pieces of furniture. I like to have all my things around me
Care Homes for Older People Page 22 of 32 Evidence: said a resident it makes you feel at home. Some of the furniture was starting to also look worn and old, and ready to be replaced. Call alarms were in each room, and we saw staff make sure they were placed so that residents could easily reach them. We saw that the dining room, lounge and bathrooms were all clean, and the bedrooms were as clean and tidy as residents wished them to be. Decoration in some of the bedrooms appeared tired, although some bedrooms had been redecorated. The corridors, although clean, were tired and ready for refreshing, as a residents comment showed My room is always fresh and clean, but the corridors in the home are not very inviting, and when my family come to see me the carpets in the corridor dont seem clean. The manager told us about plans to refurbish the entrance hall and corridors, along with acquiring more suitable chairs and more aids for residents. She also confirmed that there are plans to continually improve the decoration in the home, increase the amount of individual aids, such as special chairs and wheelchairs, and continue to replace beds and mattresses. We viewed the bathrooms and found them to be clean and tidy. They appeared practical but rather sparse, and need to be made more homely and attractive, so that residents have a good experience of their bath times. The manager told us Aids and adaptations are provided which are able to meet the residents needs, and we saw evidence of these through grab rails, assisted baths, hoists, hospital beds, cot sides, feeding aids and raised toilet seats. Staff make a record of daily maintenance requirements, as they go about their work, and the maintenance man deals with them as soon as he can, signing to say they are completed. These may be a bulb to be replaced, a tap broken, or a door handle broken. The maintenance mans role also includes redecorating, gardening, and driving the mini-bus. He also makes very regular checks on the lighting, fire alarms, nurse calls and water temperature. Good records are kept of all the tasks completed. We saw a separate, well equipped laundry room, with a laundry supervisor making sure residents clothes were cleaned and returned efficiently. The washing machines have a sluice cycle so that fouled linen can be laundered. The room has washable floor and walls, making the area easy to clean. Infection control guidelines were followed. The manager told us The home is maintained to fire and environmental health requirements. Care Homes for Older People Page 23 of 32 Care Homes for Older People Page 24 of 32 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment practices protect residents. Staff numbers meet residents needs. Evidence: The home is an equal opportunities employer, and show this with the recruitment of staff from different cultures and both male and female staff. They have a comprehensive recruitment procedure. We looked at the recruitment of staff, and there was evidence that references were sent for, and Protection of Vulnerable Adult (POVA) and Criminal Records Bureau (CRB) checks were obtained prior to starting work. The manager told us that she is considering how residents could be involved in the recruitment of new staff in the future. The manager told us that the professional qualifications of nursing staff were also checked. The staff group at the home are a mix of qualified nursing staff and care staff, experienced, or young and enthusiastic, both male and female. The workforce also includes some overseas staff. All new staff receive induction training at the start of employment so that they have the knowledge and skills to do their work. An induction pack is provided addressing the
Care Homes for Older People Page 25 of 32 Evidence: principles of care. Staff surveys reflected that the induction mostly covered everything staff needed to know to do the job when they started. Its a nice place to work, and there seems to be more effort being made to support the staff, both through training courses, and one to one supervision sessions. The manager encourages openness and discussion on issues, stated a staff member. We saw a training matrix showing courses all staff have attended. These included moving and handling, food hygiene, dementia care, equality and diversity, health and safety, and adult abuse awareness. The manager told us Training of staff in appropriate key areas is a priority. Regular assessments of changing needs enable care to be provided that meets those needs. She said that specific training would be obtained when needed, and to further develop staff skills, such as palliative care, safe swallowing, continence awareness, and information on particular illnesses. National Vocational Qualification Awards have been obtained by 42 of care staff (6 out of 14 staff), with 21 (3) presently working toward it. Once completed, the numbers of care staff with NVQ awards will have achieved the required amount (50 ), as stated in the Care Homes National Minimum Standards. Rotas were seen which showed an appropriate number of nursing and care staff on duty at all times. At the time of this visit there were appropriate numbers of staff on duty. The manager confirmed that there had been difficulties with lack of staff numbers, and the continual use of agency staff. Resident surveys stressed this fact. There are too many agency staff who do not speak good English and do not understand me, and The home does seem short of staff a lot of the time and use bank staff quite a lot and you have difficulty understanding them. Since these responses the manager told us that she has been recruiting permanent staff to the home, and now hopes to be able to reduce the numbers of agency staff used, and to develop a reliable and supportive staff team. The manager said that she was aware of the need for more staff during busy periods of the day, having assessed the needs of the residents rather than looking purely at the numbers. For example many residents needed one to one support at meal times, and encouraging independence in other residents may also take that one to one support. At present staff were not able to provide all of the one to one support needed, due to lack of numbers of staff. To be able to give such support would improve the quality of the care the home is able to provide. Care Homes for Older People Page 26 of 32 Evidence: Staff were seen to respond to call alarms within a reasonable time. Domestic staff are employed and have set routines around the home. Care Homes for Older People Page 27 of 32 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a manager in place who leads by example, and has plans to develop the service provided so that residents are cared for in the best way, and staff are trained and supported. Evidence: A qualified and registered manager is in post at the home. She holds nursing qualifications, and has several years experience in the management of care provision. There are comprehensive systems in place to regularly audit and monitor systems, and to get feedback from people living at the home, and their families, on their level of satisfaction with the service. Some of the auditing is done by the organisations Clinical Governance Team, which audits care delivery, standards and expectations. We saw that an overview of events in specific areas is sent to the organisation each month so that they are clear on how the
Care Homes for Older People Page 28 of 32 Evidence: home is running. These areas may be on the number of complaints, or the number of accidents for instance. The manager also carries out self audits, checking, for example, records are complete, training is attended and maintenance has been carried out. She said she also considers residents opinions during these audits. Development plans are devised from all of these audits, with the aim being to continually improve the standard of the service. The area manager of the organisation makes monthly visits to the home, as required by legislation, again to monitor the standard of provision. Residents are encouraged to give their opinions on how they would like their care to be provided in their own meetings, called Your Voice. Meetings used to take place, but had been stopped over time, so the new manager has re-instated them, as she said it is obviously important to know what residents feel about things. The manager confirmed that surveys are also sent to residents annually from the organisation, and they provide an analysis of the findings. We advised that the outcomes from these should be available to the residents and their families in the home. Since the last visit staff supervision sessions have been re-instated and scheduled in for all staff. The manager said she plans to make sure these are regular and meaningful for her staff. Plenty of liaison and feedback takes place, with monthly staff meetings, and information for staff at the three monthly health and safety meetings. Relatives we spoke to said Everyone is always very welcoming and approachable The manager said that she likes to encourage openness, and often walked around the home chatting to staff and residents, and making sure her office door is always left open for people to call in and speak to her. Records show regular fire training for staff, and the manager confirmed that the maintenance and servicing of equipment was up to date. There was no change in the financial procedures of the home. Staff spoken to were happy in the roles. We provide a happy and safe environment for our residents, and work to the best of our ability, was a comment. Care Homes for Older People Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 32 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations
These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 Continue to maintain the Service User Guide and Statement of Purpose so they hold up to date information about the service. Soft and blended meals should be presented in an attractive way to make them more appetising, and to encourage the resident to eat. The plans to update, decorate and refurbish the environment should continue, including the garden area. The bathroom areas should be presented in a homely way. These actions will make the home a more attractive and pleasant place to stay. The manager should continue to develop the staff team with staff who are employed by the home, reducing the numbers of agency staff used, so as to encourage reliability and good knowledge of the residents and their medical and social care needs, so improving service delivery. 50 of care staff should achieve at least NVQ level 2. The results of the homes surveys to residents should be made available to them and their families, and other interested parties, so that developments linked to the outcomes from these can be noted. 2 15 3 19 4 27 5 6 28 33 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
